Trump Mar-a-Lago pals hold up VA contract

INFLUENCE IS INFLUENCE: A West Palm Beach, Fla., internist who happens to be part of Donald Trump’s Mar-a-Lago circle has apparently put the kibosh on the VA’s $16 billion Cerner project for the past few months because he’s been unhappy with his own experience with the Cerner software he uses at two Florida hospitals, according to four former and current senior VA officials.

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With the White House’s approval, Dr. Bruce Moskowitz has participated in two or three monthly calls since November with the contracting team responsible for implementing the 10-year project, according to two former senior VA officials. Ike Perlmutter, the Marvel Entertainment chairman and a buddy of Trump’s, has also been on some calls, they said.

It’s no surprise that many doctors don’t like their EHRs, or that there’s plenty of skepticisms about the VA deal out there — especially given the early stumbles of the MHS Genesis program in the military’s four bases in the Pacific Northwest.

However, the involvement of Moskowitz and Perlmutter, which has not previously been reported, infuriated clinicians involved in the VA project, including former Secretary David Shulkin, according to one of the sources, a former senior VA official. He and the others felt that Moskowitz was out of his league in assessing the Cerner project.

“Shulkin would say, “Who the hell is this person who practices medicine in Florida and has never run a health care system?” said the source. He said Moskowitz’s involvement was a flashpoint in Shulkin’s dealings with other White House-appointed officials, which contributed to his being fired March 28.

The behind-the-scenes involvement of Moskowitz and Perlmutter illustrates the degree to which members of Trump’s social circle have been able to influence government decisions, even about extraordinarily specialized subjects.

MHS GENESIS UPDATE: At a hearing last week, Sen. Patty Murray charged that the MHS Genesis rollout at four bases in her home state was “plagued by technical problems.” Clinicians at the military facilities described “inaccurate prescription submissions, misdirected patient referrals” and “long waits to resolve problems,” she said, and some staff had to pay money out of their operating budgets to compensate for inadequate training.

— Stacy Cummings, who’s in charge of the implementation, said DoD was in the process of closing about 1,0000 of the 7,000 trouble tickets racked up through January. “[D]epending on the level of complexity and how much work needs to be done directly with the user, those changes will be made over the remainder of the year,” she said. The configuration of MHS Genesis deployed at the four bases “provided a minimally suitable starting point to assess the system, as well as the infrastructure prior to full deployment,” she acknowledged, but DoD can now “make adjustments to software, training, and workflows and be confident the changes are positive and impactful.”

— As far as she knows, Cummings said, the VA is “still moving the ball forward” on its Cerner contract. More details from the hearing here.

— While the DoD works to fix the Cerner implementation at the bases around Spokane and the Puget Sound, MultiCare Health Spokane announced it will go live with a $25 million Epic EHR implementation early this summer to improve interoperability with two other big other big state providers, Providence Washington and Kaiser Permanente. Details here.

Tweet of the Day: John Wilbanks @wilbanks To be clear on the DeAngelo DNA lookup. What I find bonkers isn’t the use of the DNA to find him - it’s the way it was done. Wouldn’t have predicted use of an exploit to achieve it, rather than barreling in the front door.

Welcome to Monday morning eHealth, where now that the Wizards are dormant until November and my Cincinnati Reds lie slumbering in the cellar, I no longer need to look at the sports page in the morning at all. And that's good, really it is. Will make me more efficient. Send time-money suggestions to aallen@politico.com, or share with the whole class @ravindranize, @athurallen202, @DariusTahir, @POLITICOPro, @Morning_eHealth.

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CMS SEEKS MORE INPUT ON INTEROPERABILITY: In three proposed hospital payment rules the agency put out late Friday, CMS included a request for information on promoting interoperability and electronic health information exchange. The payment rules for skilled nursing facilities,hospice and psychiatric hospitals each contain the addendum asking readers whether CMS should include certain buffed-up interoperability requirements in its Conditions of Participation in Medicare and Medicaid programs.

— The agency may demand that 1) hospitals transfer medical information when a patient transfers, 2) electronically send discharge information to a community provider if one can be identified, and 3) make certain data available to the patient or caregiver by electronic means, according to the request. It also asks whether such measures would help reduce information blocking or would be overly burdensome, and seeks suggestions on compliance deadlines.

ONC HEAD PLUGS ‘PERSISTENT ACCESS’: National Coordinator for Health IT Don Rucker said a key part of making health data more accessible is giving patients uninterrupted access to their EHRs, instead of forcing them to constantly re-authenticate via apps. During a Health Datapalooza keynote Friday, Rucker said the agency is examining what’s required for “persistent access,” including electronic consent, privacy and authentication protocols. He suggested modeling EHR-related apps after airline apps, where “every time the flight is delayed, you don’t have to actually sign on again” to get an update.

CAN TELEMEDICINE DO MORE THAN DE-TETHER PATIENTS?: Telemedicine should do more than just replace physical consultations, says Bob Wachter, digital health expert and chairman of the medicine department at University of California, San Francisco. Distant doctoring should wrap in AI, sensors, and new tech tools to dramatically re-imagine care, he told the American Telemedicine Association’s conference in Chicago in a keynote address Sunday. Established health IT vendors like Epic and Cerner won’t lead the charge to integrate telemedicine technology into EHRs, Wachter predicted, but others will use their APIs to dream up new ways to connect health data to telemedicine platforms. The most valuable telemedicine applications probably won't emerge until doctors have been using the technology a while and dream up new ways to improve care. “Will telemedicine lead people to reimagine the work, or merely de-tether patients and clinicians from a site of care?” he asked. ”If all it does is de-tether patients...I don’t think it will have reached its potential.”

CHALLENGING AN ALGORITHM: A state judge today is expected to rule on whether the Arkansas Department of Human Services must abandon an algorithm it has been using to determine what level of nursing support it gives 8,300 disabled people. The case involves seven plaintiffs who say their services were cut starting in 2016 when the state started using a computer program, rather than a nurse’s expert judgement, to decide how many hours of nursing support they get. The plaintiffs suffer from devastating conditions like cerebral palsy and multiple sclerosis, said their attorney, Kevin De Liban.

— The program take information from 61 questions answered by the patients or their caregivers and uses it to assign them to one of 23 groups, each of which gets a fixed number of hours of help. “At first my clients couldn’t figure out what was going on, but they were all losing their hours,” De Liban said. “All the nurse would say is, 'The computer says it. It’s the computer that decides now.’" The state acknowledged that it was using the system in November 2016 in response to an earlier lawsuit. the current case, De Liban is seeking summary judgement to end the practice. Read background on the case here.

SAFER GUIDES NOT MAKING EHRS SAFER YET: Few health systems are close to implementing the ONC-sponsored guides released in 2014 to help them make sure they avoid safety risks inherent in using electronic health records, according to a study in the Journal of the American Medical Informatics Association. The authors, led by Dean Sittig pf the University of Texas Health Science Center in Houston, conducted risk assessments of 8 organizations of varying size, complexity and EHR adoption. The sites fully implemented a total of 25 of 140 recommendations from the ONC SAFER guides. New national policy initiatives are needed to stimulate best practices, the authors write.

About The Author

Arthur Allen is the eHealth editor for POLITICO Pro.

Becoming editor of eHealth at Politico marked Allen’s return to the newsroom after 18 years of solitude (apologies to Gabriel Garcia Marquez). As a freelancer beginning in 1996, he wrote for publications and websites such as The Washington Post, The New York Times, The New Republic, Slate.com, Landscape Architecture, Global Health Matters, Science and Mother Jones. He also wrote three books, the last of which, “The Fantastic Laboratory of Dr. Weigl,” comes out in July 2014 (buy your advance copy now!) Once upon a time, when the hairs on Allen’s head were as numerous as pissants on a melon stalk, he was a wire service reporter. He toiled for The Associated Press for the better part of 13 years, including stints in El Salvador, Mexico and Germany. Allen is married to Margaret Talbot; their son heads off to college soon but for now they still have the company of a teenage daughter with impeccable taste in music and style. During Allen’s non-wage earning hours, he may be found playing pickup basketball, studying Polish, reading 19th century novels, or hunting fruitlessly for morels and other edible mushrooms.